We are embarking on a great experiment in the delivery of healthcare. Like all good experiments, this one has a hypothesis and the hypothesis is that we can improve care by offering providers incentives for quality. That is a very worthy goal, but the big and untested assumptions are that we can measure quality and that the incentives are sufficient to change behavior—to the extent that behavior needs to be changed. Of course, we can change the equation by reducing reimbursement for lack of quality, but let’s not go there right now.
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At times like this, as I look at the future of my specialty, I feel like the patient who has gout. I am in fear. My anxiety is high and, in anticipation of the next attack (in this case, more regulations and bureaucracy), I worry that a wave of fearsome and flaming pain is rushing toward me.
An I a realist or a Chicken Little when it comes to the future?
Please write in to [email protected]. You helped me on my last case. Now help me on this one.
Dr. Pisetsky is physician editor of The Rheumatologist and professor of medicine and immunology at Duke University Medical Center in Durham, N.C.